Volume 14 Supplement 3

Lupus 2012: New targets, new approaches

Open Access

Hopkins Lupus Cohort: assessment of treatment effects

  • M Petri1
Arthritis Research & Therapy201214(Suppl 3):A52

DOI: 10.1186/ar3986

Published: 27 September 2012

Introduction

The Hopkins Lupus Cohort is a longitudinal study in which all SLE patients are seen quarterly, by protocol, by one rheumatologist. The specific aims include prevention of organ damage. In this abstract, two projects - noncalcified plaque (NCP) and treatment of antiphospholipid antibodies - will be reviewed.

Methods

For the study on NCP, 64-slice (n = 106) or 320-slice (n = 121) coronary multidetector computed tomography (MDCT) was performed in 227 patients with SLE. The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software. The NCP score was a sum of plaque severity multiplied by the plaque composition divided by the number of vessels examined.

For the study on treatment of antiphospholipid antibodies, we studied 1,795 SLE patients (56% Caucasian, 37% African American, 93.3% female, mean age 37.0 ± 12.5) with no previous thrombosis prior to entry in the cohort. The primary outcome was first thrombotic event (arterial or venous). Univariate analysis and multivariable modeling were used to examine associations between prednisone, hydroxycholoquine, and NSAID use with the risk of thrombosis.

Results

The multiple regression model for the mean level of NCP is shown in Table 1. The multiple regression model for prevention of thrombosis is presented in Table 2.

Table 1

Variable

Effect on mean NCP score (95% CI)

P value

Age (per 10 years)

0.085 (0.057 to 0.113)

<0.0001

Low BMI (vs. normal)

-0.096 (-0.175 to -0.018)

0.017

High BMI (vs. normal)

0.002 (-0.080 to 0.084)

0.96

Hypertension

0.065 (-0.005 to 0.136)

0.068

History of low C3

0.090 (0.020 to 0.161)

0.012

History of ant-dsDNA

0.031 (-0.042 to 0.103)

0.40

Male sex

0.087 (-0.017 to 0.191)

0.10

Methotrexate current

0.279 (0.113 to 0.445)

0.0011

Table 2

 

Subgroup

Thrombotic events

Rate of events/1,000 person-years

Rate ratios (95% CI)

P value

Current prednisone

None

52

10.6

1.0 (Ref. Gp)

 
 

1 to 9 mg/day

40

16.4

1.6 (1.1 to 2.4)

0.025

 

10 to 19 mg/day

49

34.3

3.3 (2.2 to 4.8)

<0.0001

 

20+ mg/day

43

71.8

6.5(4.3 to 9.8)

<0.0001

Cumulative prednisone dose

None

29

13.1

1.0 (Ref. Gp)

 
 

<1 year (10 mg/day)

37

23.8

1.6 (1.0 to 2.6)

0.075

 

1 to 3 years (10 mg/day)

30

19.0

1.8 (1.1 to 3.1)

0.026

 

3 to 10 years (10 mg/day)

45

25.5

3.0 (1.8 to 5.2)

<0.0001

 

>10 years (10 mg/day)

9

24.3

3.7 (1.5 to 9.4)

0.0056

Current HCQ

No

95

29.0

1.0 (Ref. Gp)

 
 

Yes

90

14.6

0.5 (0.4 to 0.7)

<0.0001

HCQ use

Never

57

32.2

1.0 (Ref. Gp)

 
 

Past (not current)

27

27.6

0.9 (0.6 to 1.5)

0.81

 

<6 consecutive months

16

20.0

0.6 (0.3 to 1.0)

0.056

 

>6 consecutive months

64

13.8

0.5 (0.3 to 0.7)

0.0003

NSAID use

No

146

21.6

1.0 (Ref. Gp)

 
 

Yes

37

13.9

0.6 (0.4 to 0.9)

0.017

Aspirin use

No

137

17.9

1.0 (Ref. Gp)

 
 

Yes

49

28.0

1.6 (1.2 to 2.3)

0.0038

Conclusion

For NCP, methotrexate increased NCP, possibly via homocysteine. For thrombosis, hydroxychloroquine significantly reduced thrombosis, but prednisone increased it. SLE longitudinal cohorts can address many clinical questions that are not suitable for clinical trials.

Authors’ Affiliations

(1)
Johns Hopkins

Copyright

© Petri; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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